Third of UK hospital Covid patients had ‘do not resuscitate’ order in first wave
Almost a third of patients admitted to hospital with suspected Covid-19 during the first wave of the pandemic had a “do not resuscitate” decision recorded before or on their day of admission, research suggests.
This is higher than the rates reported in previous studies of conditions similar to Covid-19 before the pandemic, according to a study from the University of Sheffield’s School of Health and Related Research (ScHARR), one of the first to quantify the use of such orders in the pandemic.
The research, published in the journal Resuscitation, found that 59% of patients with a do not attempt cardiopulmonary resuscitation (DNACPR) decision survived their acute illness and 12% received intensive treatment aimed at saving their life.
The study, funded by the National Institute for Health Research, found 31% of patients admitted to UK hospitals with suspected Covid-19 during the first wave of the pandemic had a DNACPR decision recorded before or on their day of admission to hospital.
People with a DNACPR decision received some intensive treatments as frequently as those with no DNACPR decision, researchers found, which provides reassurance that doctors were not denying patients with DNACPR decisions potentially life-saving treatment.
The research also found that people of Asian ethnicity were less likely to have a DNACPR decision on or before their day of admission to hospital.
The reasons for this are not clear and the researchers highlighted the need for further studies into the discussions that take place when people from ethnic minorities are admitted to hospital with Covid-19 or other serious illnesses.
The findings come from the University of Sheffield-led Priest study, which was originally set up to evaluate ways of assessing the severity of Covid-19 in people attending emergency departments.
The research team analysed data relating to DNACPR decisions from 12,748 adults in the study after the Care Quality Commission (CQC) undertook a review of the use of DNACPR decisions in the pandemic.
In March, the CQC called for ministerial involvement to tackle the “worrying variation” in people’s experiences of DNACPR decisions, with some families not properly involved and others unaware that decisions had been made.
It said that a combination of “unprecedented pressure” on providers and “rapidly developing guidance” may have led to situations where DNACPR decisions were incorrectly conflated with other clinical assessments.
There were examples of good practice but the regulator also found a “worrying picture” of poor involvement of people using services, poor record keeping, and a lack of oversight and scrutiny of the decisions being made.
Ireland is to double to 10 days its quarantine period for travellers from the UK who are not fully vaccinated, joining a growing list of countries imposing stricter travel rules on British arrivals due to concerns over the rapid spread of the Delta variant.
The announcement came after Boris Johnson on Monday delayed by a month the final stage of England’s exit from lockdown amid accusations the government should have acted faster by placing India, where the variant was first detected, on its red restricted-travel list before 23 April.
Neighbouring Pakistan and Bangladesh had been added to the UK’s red list on 9 April, with India following a fortnight later, four days after a visit to the country during which Johnson hoped to announce a new trade deal was called off.
The Delta variant accounts for 90% of new UK cases and critics have argued that since half of early infections involved international travel, a ban on all arrivals except UK citizens and residents should, as some argued at the time, have been imposed earlier.
In fact, Britain was one of the first major western countries to severely restrict travel from India over Delta variant concerns. The French government announced a mandatory 10-day quarantine and test for all arrivals from India on 22 April, with Germany following suit four days later.
Berlin designated India as a “virus variant area with a significantly elevated risk of infection”, in effect barring entry to the country, even with a valid visa, for almost everyone – except German nationals – who visited India during the last 10 days.
Italy’s ban came on 25 April, prohibiting entry for travellers who have been in India in the past 14 days. Like many other EU states, exemptions are essentially available only to nationals, residents and to those with an urgent humanitarian reason – such as a close family bereavement – to travel.
The US did not tighten its restrictions until 4 May, after the US Centers for Disease Control and Prevention (CDC) placed India at the highest level on its risk scale, warning that even vaccinated travellers may get and spread variants.
Australia at first banned even its own citizens from returning from India on 27 April, with the prime minister, Scott Morrison, warning anyone who tried risked up to five years in jail and a $50,000 fine, but backed down a fortnight later in the face of public outcry.
However, although the UK acted at about the same time as other countries, the volume of traffic between Britain and its former colony is generally higher than between India and most EU member states, potentially justifying earlier action.
In addition, most EU states earlier this year denied entry to travellers from almost all non-EU countries, with the exception of their own nationals and residents and people with proof of “an imperative personal or family reason”, an emergency medical appointment or a professional trip that could not be postponed.
According to the Civil Aviation Authority, about 50,000 people travelled between India and the UK in February, nearly 900 a day in each direction. On 13 May, Public Health England found nearly half of Delta variant cases in England were travellers.
Ireland’s transport minister, Eamon Ryan, said Dublin’s decision “reflects concern about the Delta variant, and to try to hold back the development of that variant here as much as we can and give us time to get vaccines out to give us cover against it”.
The move follows France’s recent decision to allow travellers from the UK who are fully vaccinated to enter the country with a negative test, but demand that those who are not have an essential reason for travel and a negative test. They must also complete a seven-day quarantine.
Germany declared the UK a virus variant area of concern on 23 May, meaning only German citizens or residents and their immediate family, plus those with an urgent humanitarian reason, may enter the country from the UK.